SpringerLink
Log in

Safety and Tolerability of Rituximab in the Treatment of Systemic Sclerosis

  • BIOCHEMISTRY, BIOPHYSICS, AND MOLECULAR BIOLOGY
  • Published:
Doklady Biochemistry and Biophysics Aims and scope Submit manuscript

Abstract

Rituximab (RTX) has been used for the treatment of systemic sclerosis (SSс) for a long time and has shown good efficacy for skin fibrosis and interstitial lung disease (ILD). However, data on tolerability and long-term adverse events (AEs) during RTX therapy in SSc are insufficient. The objective of this study was to assess the tolerability and safety of RTX in patients with SSс in a long-term prospective follow-up. Our open-label prospective study included 151 SSс patients who received at least one RTX infusion. The mean age of the patients was 47.9 ± 13.4 years; the majority of them were women (83%). The mean disease duration was 6.4 ± 5.8 years. The mean follow-up period after the first RTX infusion was 5.6 ± 2.6 years (845.6 patient-years (PY)). All patients received RTX in addition to ongoing therapy with prednisone and/or immunosuppressants. AEs were assessed and recorded by a doctor in the hospital immediately after RTX infusion and then by patient’s reported outcome during the observation period. All causes of death were considered, regardless of treatment. A total of 85 AEs (56%) were registered, the overall incidence of AEs was 10/100 PY (95% confidence interval (CI) 8–12). The highest frequency of all AEs was observed in the first 2–6 months after the first course of RTX, however, these were mainly mild and moderate AEs (71%). The most frequent AEs were infections, they were observed in 40% of cases, with no serious opportunistic infections reported. The overall incidence of all infections was 7.1/100 PY (95% CI 5.5–9), serious infections—1.5/100 PY (95% CI 0.9–2.6). Infusion reactions occurred in 8% of patients. Other AEs were noted in 3% (0.6/100 PY, 95% CI 0.3–1.4). The overall incidence of serious AEs was 18%—3.2/100 PY (95% CI 2.2–4.6). There was a significant decrease of the immunoglobulin G (Ig G) during follow-up; however, its average values remained within normal limits. There were 17 deaths (11%) (2/100 PY, 95% CI 1.3–3.2). In most cases, patients died from the progression of the major organ failure, which arose before RTX treatment. In our study, the safety profile of RTX in SSс was assessed as favorable. It was similar to the AE profile in other autoimmune diseases treated with RTX. With an increase in the cumulative dose of RTX, no increase in AEs was observed. The mortality is comparable to the other severe autoimmune diseases in observational studies. Monitoring of IgG may be useful for patients with SSс on RTX therapy for early detection of the risk of develo** infectious complications. RTX could be considered as a relatively safe drug for the complex therapy of SSс when standard therapy is ineffective or impossible.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Denton, Ch.P. and Khanna, D., Systemic sclerosis, Lancet, 2017, vol. 390, no. 10103, pp. 1685–1699. https://doi.org/10.1016/s0140-6736(17)30933-9

    Article  PubMed  Google Scholar 

  2. Stern, E.P. and Denton, Ch.P., The pathogenesis of systemic sclerosis, Rheum. Dis. Clin. North Am., 2015, vol. 41, no. 3, pp. 367–382. https://doi.org/10.1016/j.rdc.2015.04.002

    Article  PubMed  Google Scholar 

  3. Brown, M. and O’Reilly, S., The immunopathogenesis of fibrosis in systemic sclerosis, Clin. Exp. Immunol., 2019, vol. 195, no. 3, pp. 310–321. https://doi.org/10.1111/cei.13238

    Article  CAS  PubMed  Google Scholar 

  4. Thoreau, B., Chaigne, B., and Mouthon, L., Role of B-cell in the pathogenesis of systemic sclerosis, Front. Immunol., 2022, vol. 12, no. 13, p. 933468. https://doi.org/10.3389/fimmu.2022.933468

    Article  CAS  Google Scholar 

  5. Ananieva, L.P., Current therapy of interstitial pneumonia associated with systemic scleroderma, Nauchno-Prakt. Revmatol., 2020, vol. 58, no. 5, pp. 520–531. https://doi.org/10.47360/1995-4484-2020-520-531

    Article  Google Scholar 

  6. Yoshizaki, A., B lymphocytes in systemic sclerosis: abnormalities and therapeutic targets, J. Dermatol., 2016, vol. 43, no. 1, pp. 39–45. https://doi.org/10.1111/1346-8138.13184

    Article  CAS  PubMed  Google Scholar 

  7. Sanges, S., Guerrier, T., Launay, D., Lefèvre, G., Labalette, M., Forestier, A., Sobanski, V., Corli, J., Hauspie, C., Jendoubi, M., Yakoub-Agha, I., Hatron, P.-Y., Hachulla, E., and Dubucquoi, S., Role of B cells in the pathogenesis of systemic sclerosis, Rev. Med. Interne, 2017, vol. 38, no. 2, pp. 113–124. https://doi.org/10.1016/j.revmed.2016.02.016

    Article  CAS  PubMed  Google Scholar 

  8. Jordan, S., Distler, J.H.W., Maurer, B., Huscher, D., Van Laar, J.M., Allanore, Ya., and Distler, O., Effects and safety of rituximab in systemic sclerosis: an analysis from the European Scleroderma Trial and Research (EUSTAR) group, Ann. Rheumatic Dis., 2015, vol. 74, no. 6, pp. 1188–1194. https://doi.org/10.1136/annrheumdis-2013-204522

    Article  CAS  Google Scholar 

  9. Daoussis, D., Melissaropoulos, K., Sakellaropoulos, G., Antonopoulos, I., Markatseli, T.E., Simopoulou, T., Georgiou, P., Andonopoulos, A.P., Drosos, A.A., Sakkas, L., and Liossis, S.-N., A multicenter, open-label, comparative study of B-cell depletion therapy with Rituximab for systemic sclerosis-associated interstitial lung disease, Semin. Arthritis Rheum., 2017, vol. 46, no. 5, pp. 625–631. https://doi.org/10.1016/j.semarthrit.2016.10.003

    Article  CAS  PubMed  Google Scholar 

  10. Thiebaut, M., Launay, D., Rivière, S., Mahévas, T., Bellakhal, S., Hachulla, E., Fain, O., and Mekinian, A., Efficacy and safety of rituximab in systemic sclerosis: French retrospective study and literature review, Autoimmun. Rev., 2018, vol. 17, no. 6, pp. 582–587. https://doi.org/10.1016/j.autrev.2017.12.010

    Article  CAS  PubMed  Google Scholar 

  11. Elhai, M., Boubaya, M., Distler, O., Smith, V., Matucci-Cerinic, M., Alegre Sancho, J.J., Truchetet, M.-E., Braun-Moscovici, Yo., Iannone, F., Novikov, P.I., Lescoat, A., Siegert, E., Castellví, I., Airó, P., Vettori, S., De Langhe, E., Hachulla, E., Erler, A., Ananieva, L., Krusche, M., López-Longo, F.J., Distler, J.H.W., Hunzelmann, N., Hoffmann-Vold, A.-M., Riccieri, V., Hsu, V.M., Pozzi, M.R., Ancuta, C., Rosato, E., Mihai, C., Kuwana, M., Saketkoo, L.A., Chizzolini, C., Hesselstrand, R., Ullman, S., Yavuz, S., Rednic, S., Caimmi, C., Bloch-Queyrat, C., and Allanore, Ya., Outcomes of patients with systemic sclerosis treated with rituximab in contemporary practice: a prospective cohort study, Ann. Rheum. Dis., 2019, vol. 78, no. 7, pp. 979–987. https://doi.org/10.1136/annrheumdis-2018-214816

    Article  CAS  PubMed  Google Scholar 

  12. Ananyeva, L.P., Garzanova, L.A., Koneva, O.A., Starovoytova, M.N., Desinova, O.V., Ovsyannikova, O.B., Shayakhmetova, R.U., Cherkasova, M.V., Aleksan-kin, A.P., and Nasonov, E.L., Anti-topoisomerase 1 antibody level changes after B cell depletion therapy in systemic sclerosis, Nauchno-Prakt. Revmatol., 2022, vol. 60, no. 1, pp. 57–63. https://doi.org/10.47360/1995-4484-2022-57-63

    Article  Google Scholar 

  13. Ananyeva, L.P., Koneva, O.A., Desinova, O.V., Garzanova, L.A., Glukhova, S.I., Starovoitova, M.N., Ovsyannikova, O.B., Volkov, A.V., Aleksankin, A.P., and Nasonov, E.L., Effect of rituximab on the manifestations of activity and pulmonary function in patients with systemic sclerosis: one-year follow-up evaluation, Nauchno-Prakt. Revmatol., 2019, vol. 57, no. 3, pp. 265–273. https://doi.org/10.14412/1995-4484-2019-265-273

    Article  Google Scholar 

  14. Ananieva, L.P., Desinova, O.V., Koneva, O.A., Starovoitova, M.N., Yutkina, N.N., Volkov, A.V., Ovsyannikova, O.B., Aleksankin, A.P., Aleksandrova, E.N., Novikov, A.A., and Nasonov, E.L., Rituximab treatment for interstitial lung injury in scleroderma systematica, Nauchno-Prakt. Revmatol., 2013, vol. 51, no. 5, pp. 514–523. https://doi.org/10.14412/1995-4484-2013-1542

    Article  Google Scholar 

  15. Anti-B- kletochnaya terapiya v revmatologii: fokus na rituksimab (Anti-B-Cell Therapy in Rheumatology: Focus on Rituximab), Nasonov, E.L., Ed., Moscow: IMA-PRESS, 2012.

    Google Scholar 

  16. Ebata, S., Yoshizaki-Ogawa, A., Sato, Sh., and Yoshizaki, A., New era in systemic sclerosis treatment: recently approved therapeutics, J. Clin. Med., 2022, vol. 8, no. 11 (15), p. 4631. https://doi.org/10.3390/jcm11154631

  17. Fernández-Codina, A., Walker, K.M., Pope, J.E., and Group, S.A., Treatment algorithms for systemic sclerosis according to experts, Arthritis Rheumatol., 2018, vol. 70, no. 11, pp. 1820–1828. https://doi.org/10.1002/art.40560

    Article  CAS  PubMed  Google Scholar 

  18. Tang, R., Yu, J., Shi, Ya., Zou, P., Zeng, Zh., Tang, B., Wang, Ya., Ling, G., Luo, M., and **ao, R., Safety and efficacy of Rituximab in systemic sclerosis: a systematic review and meta-analysis, Int. Immunopharmacol., 2020, vol. 83, p. 106389. https://doi.org/10.1016/j.intimp.2020.106389

    Article  CAS  PubMed  Google Scholar 

  19. De Figueiredo Caldas, M.M.V., De Azevedo, K.P.M., De França Nunes, A.C., De Oliveira, V.H., Pimen-ta, I.D.S.F., De Araújo, I.D.T., Neto, F.A.B., Da Silveira Gonçalves De Oliveira, A.K., and Piuvezam, G., Is rituximab effective for systemic sclerosis? A systematic review and meta-analysis, Adv. Rheumatology, 2021, vol. 61, no. 1, p. 15. https://doi.org/10.1186/s42358-021-00170-y

    Article  Google Scholar 

  20. Goswami, R.P., Ray, A., Chatterjee, M., Mukherjee, A., Sircar, G., and Ghosh, P., Rituximab in the treatment of systemic sclerosis–related interstitial lung disease: a systematic review and meta-analysis, Rheumatology, 2021, vol. 60, no. 2, pp. 557–567. https://doi.org/10.1093/rheumatology/keaa550

    Article  CAS  PubMed  Google Scholar 

  21. Kaegi, C., Wuest, B., Schreiner, J., Steiner, U.C., Vul-taggio, A., Matucci, A., Crowley, C., and Boyman, O., Systematic review of safety and efficacy of rituximab in treating immune-mediated disorders, Front. Immunol., 2019, vol. 6, no. 10, p. 1990. https://doi.org/10.3389/fimmu.2019.01990

    Article  CAS  Google Scholar 

  22. Ananieva, L.P., Soloviyov, S.K., Beketova, T.V., Vasiliev, V.I., Antelava, O.A., Aleksandrova, E.N., Koneva, O.A., Tsanyan, M.E., Desinova, O.V., Logvinenko, O.A., Volkov, A.V., Helkovskaya-Sergeeva, A.N., Novikov, A.A., Aleksankin, A.A., and Nasonov, Y.L., Anti-B-cell therapy at immune inflammatory rheumatic diseases: efficacy and tolerability in 229 patients, Nauchno-Prakt. Revmatol., 2014, vol. 52, no. 5, pp. 495–506. https://doi.org/10.14412/1995-4484-2014-495-506

    Article  Google Scholar 

  23. Nasonov, E.L., Beketova, T.V., Ananyeva, L.P., Vasi-lyev, V.I., Solovyev, S.K., and Avdeeva, A.S., Prospects for anti-B-cell therapy in immuno-inflammatory rheumatic diseases, Nauchno-Prakt. Revmatol., 2019, vol. 57, pp. 1–40. https://doi.org/10.14412/1995-4484-2019-3-40

    Article  Google Scholar 

  24. Sircar, G., Goswami, R.P., Sircar, D., Ghosh, A., and Ghosh, P., Intravenous cyclophosphamide vs rituximab for the treatment of early diffuse scleroderma lung disease: open label, randomized, controlled trial, Rheumatology (Oxford), 2018, vol. 57, no. 12, pp. 2106–2113. https://doi.org/10.1093/rheumatology/key213

    Article  CAS  PubMed  Google Scholar 

  25. Nasonov, E.L., Zonova, E.V., Ivanova, O.N., Knyazeva, L.A., Mazurov, V.I., Samigullina, R.R., Marusenko, I.M., Nesmeyanova, O.B., Plaksina, T.V., Sizi-kov, A.E., Krechikova, D.G., Petrochenkova, N.A., Shapovalova, Yu.S., Soroka, N.S., Pimanov, S.I., Pristrom, A.M., Kunder, E.V., Chernyaeva, E.V., Eremeeva, A.V., and Ivanov, R., The results of a phase III comparative clinical trial of rituximab (AcellbiaT and Sabthera®) in rheumatoid arthritis (The BIORA study), Nauchno-Prakt. Revmatol., 2016, vol. 54, no. 5, pp. 510–519. https://doi.org/10.14412/1995-4484-2016-510-519

    Article  Google Scholar 

  26. Woodworth, T., Furst, D.E., Alten, R., Bingham, C.O.3., Yocum, D., and Sloan, V., Standardizing assessment and reporting of adverse effects in rheumatology clinical trials II: the Rheumatology Common Toxicity Criteria v.2.0, J. Rheumatol., 2007, vol. 34, no. 6, pp. 1401–1414. https://doi.org/10.3899/jrheum.071401.c1

    Article  PubMed  Google Scholar 

  27. Stach, Ch.M., Sloan, V.S., Woodworth, T.G., Kilgallen, B., and Furst, D.E., Rheumatology Common Toxicity Criteria (RCTC): an update reflecting real-world use, Drug Saf., 2019, vol. 42, no. 12, pp. 1499–1506. https://doi.org/10.1007/s40264-019-00864-9

    Article  PubMed  Google Scholar 

  28. Vital, E.M., Dass, Sh., Buch, M.H., Rawstron, A.C., and Emery, P., An extra dose of rituximab improves clinical response in rheumatoid arthritis patients with initial incomplete B cell depletion: a randomised controlled trial, Ann. Rheum. Dis., 2015, vol. 74, no. 6, pp. 1195–1201. https://doi.org/10.1136/annrheumdis-2013-204544

    Article  CAS  PubMed  Google Scholar 

  29. Moradzadeh, M., Aghaei, M., Mehrbakhsh, Z., Arab-Bafrani, Z., and Abdollahi, N., Efficacy and safety of rituximab therapy in patients with systemic sclerosis disease (SSc): systematic review and meta-analysis, Clin. Rheumatol., 2021, vol. 40, no. 10, pp. 3897–3918. https://doi.org/10.1007/s10067-021-05698-4

    Article  PubMed  Google Scholar 

  30. **ng, N.-S., Fan, G.-Z., Yan, F., Liu, Y.-P., and Zhang, R., Safety and efficacy of rituximab in connective tissue disease-associated interstitial lung disease: a systematic review and meta-analysis, Int. Immunopharmacol., 2021, vol. 95, p. 107524. https://doi.org/10.1016/j.intimp.2021.107524

    Article  CAS  PubMed  Google Scholar 

  31. Vogel, W.H., Infusion reactions: diagnosis, assessment, and management, Clin. J. Oncol. Nurs., 2010, vol. 14, no. 2, pp. e10–e21. https://doi.org/10.1188/10.cjon.e10-e21

    Article  PubMed  Google Scholar 

  32. Giuggioli, D., Lumetti, F., Colaci, M., Fallahi, P., Antonelli, A., and Ferri, C., Rituximab in the treatment of patients with systemic sclerosis. Our experience and review of the literature, Autoimmun. Rev., 2015, vol. 14, no. 11, pp. 1072–1078. https://doi.org/10.1016/j.autrev.2015.07.008

    Article  CAS  PubMed  Google Scholar 

  33. Daoussis, D., Liossis, S.-N.C., Tsamandas, A.C., Kalogeropoulou, Ch., Kazantzi, A., Sirinian, Ch., Karampetsou, M., Yiannopoulos, G., and Andonopoulos, A.P., Experience with rituximab in scleroderma: results from a 1-year, proof-of-principle study, Rheumatology, 2010, vol. 49, no. 2, pp. 271–280. https://doi.org/10.1093/rheumatology/kep093

    Article  CAS  PubMed  Google Scholar 

  34. Sari, A., Guven, D., Armagan, B., Erden, A., Kalyoncu, U., Karadag, O., Apras Bilgen, S., Ertenli, I., Kiraz, S., and Akdogan, A., Rituximab experience in patients with long-standing systemic sclerosis–associated interstitial lung disease, J. Clin. Rheumatol., 2017, vol. 23, no. 8, pp. 411–415. https://doi.org/10.1097/rhu.0000000000000584

    Article  PubMed  Google Scholar 

  35. Lepri, G., Avouac, J., Airò, P., Anguita Santos, F., Bellando Randone, S., Blagojevic, J., Distler, O., Garcìa Hernàndez, F.J., Gonzalez Nieto, J.A., Guiducci, S., Jordan, S., Limaye, V., Maurer, B., Riccieri, V., Selva-O’calaghan, A., Matucci Cerinic, M., and Allanore, Y., Effects of rituximab in connective tissue disorders related interstitial lung disease, Clin. Exp. Rheumatol., 2016, vol. 34, no. suppl 100 5, pp. 181–185.

  36. Zonozi, R., Wallace, Z.S., Laliberte, K., Huizenga, N.R., Rosenthal, J.M., Rhee, E.P., Cortazar, F.B., and Niles, J.L., Incidence, clinical features, and outcomes of late-onset neutropenia from rituximab for autoimmune disease, Arthritis Rheumatol., 2021, vol. 73, no. 2, pp. 347–354. https://doi.org/10.1002/art.41501

    Article  CAS  PubMed  Google Scholar 

  37. Curtis, J.R., Yang, S., Patkar, N.M., Chen, L., Singh, J.A., Cannon, G.W., Mikuls, T.R., Delzell, E., Saag, K.G., Safford, M.M., Duvall, S., Alexander, K., Napalkov, P., Winthrop, K.L., Burton, M.J., Kamauu, A., and Baddley, J.W., Risk of hospitalized bacterial infections associated with biologic treatment among us veterans with rheumatoid arthritis, Arthritis Care Res. (Hoboken), 2014, vol. 66, no. 7, pp. 990–997. https://doi.org/10.1002/acr.22281

    Article  CAS  PubMed  Google Scholar 

  38. Roberts, D.M., Jones, R.B., Smith, R.M., Alberici, F., Kumaratne, D.S., Burns, S., and Jayne, D.R.W., Rituximab-associated hypogammaglobulinemia: incidence, predictors and outcomes in patients with multi-system autoimmune disease, J. Autoimmun., 2015, vol. 57, pp. 60–65. https://doi.org/10.1016/j.jaut.2014.11.009

    Article  CAS  PubMed  Google Scholar 

  39. Sharif, K., Watad, A., Bragazzi, N.L., Asher, E., Abu Much, A., Horowitz, Y., Lidar, M., Shoenfeld, Y., and Amital, H., Anterior ST-elevation myocardial infarction induced by rituximab infusion: a case report and review of the literature, J. Clin. Pharm. Ther., 2017, vol. 42, no. 3, pp. 356–362. https://doi.org/10.1111/jcpt.12522

    Article  CAS  PubMed  Google Scholar 

  40. Koneva, O., Ananyeva, L.P., Garzanova, L., Desinova, O., Ovsyannikova, O., and Starovoytova, M., Rituximab and cyclophosphamide comparison for efficacy and safety in the patients with systemic sclerosis associated with interstitial lung disease, Ann. Rheum. Dis., 2019, vol. 78, p. 169.

    Google Scholar 

  41. St Clair, E.W., Good and bad memories following rituximab therapy, Arthritis Rheum., 2010, vol. 62, no. 1, pp. 1–5. https://doi.org/10.1002/art.25039

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Genno-inzhenernye biologicheskie preparaty v lechenii revmatoidrogo artrita (Biological Drugs in the Treatment of Rheumatoid Arthritis), Nasonov, E.L., Ed., Moscow: IMA-PRESS, 2013.

    Google Scholar 

  43. Guillevin, L., Pagnoux, Ch., Karras, A., Khouatra, Ch., Aumaître, O., Cohen, P., Maurier, F., Decaux, O., Ninet, J., Gobert, P., Quémeneur, T., Blanchard-Delaunay, C., Godmer, P., Puéchal, X., Carron, P.-L., Hatron, P.-Y., Limal, N., Hamidou, M., Ducret, M., Daugas, E., Papo, T., Bonnotte, B., Mahr, A., Ravaud, P., and Mouthon, L., Rituximab versus azathioprine for maintenance in ANCA-associated vasculitis, New Engl. J. Med., 2014, vol. 371, pp. 1771–1780. https://doi.org/10.1056/nejmoa1404231

    Article  PubMed  Google Scholar 

  44. Charles, P., Terrier, B., Perrodeau, E., Cohen, P., Faguer, S., Huart, A., et al., Comparison of individually tailored versus fixed-schedule rituximab regimen to maintain ANCA-associated vasculitis remission: results of a multicentre, randomised controlled, phase III trial (MAINRITSAN2, Ann. Rheum. Dis., 2018, vol. 77, pp. 1143–1149. https://doi.org/10.1136/annrheumdis-2017-212878corr1

    Article  PubMed  Google Scholar 

  45. Rovin, B.H., Furie, R., Latinis, K., Looney, R.J., Fervenza, F.C., Sanchez-Guerrero, et al., Group, L.U.N.A.R.I., Efficacy and safety of rituximab in patients with active proliferative lupus nephritis: the lupus nephritis assessment with rituximab study, Arthritis Rheum., 2012, vol. 64, no. 4, pp. 1215–1226. https://doi.org/10.1002/art.34359

    Article  CAS  PubMed  Google Scholar 

  46. Oddis, Ch.V., Reed, A.M., Aggarwal, R., Rider, L.G., Ascherman, D.P., Levesque, M.C., Barohn, R.J., Feldman, B.M., Harris-love, M.O., Koontz, D.C., Fertig, N., Kelley, S.S., Pryber, Sh.L., Miller, F.W., and Rockette, H.E., Rituximab in the treatment of refractory adult and juvenile dermatomyositis and adult polymyositis: a randomized, placebo-phase trial, Arthritis Rheum., 2013, vol. 65, no. 2, pp. 314–324. https://doi.org/10.1002/art.37754

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This work was supported by ongoing institutional funding. No additional grants to carry out or direct this particular research were obtained.

Author information

Authors and Affiliations

  1. Nasonova Research Institute of Rheumatology, Moscow, Russia

    L. A. Garzanova, L. P. Ananyeva, O. A. Koneva, O. V. Desinova, M. N. Starovoytova, O. B. Ovsyannikova, R. U. Shayakhmetova & S. I. Glukhova

Authors
  1. L. A. Garzanova
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. P. Ananyeva
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. O. A. Koneva
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. O. V. Desinova
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. N. Starovoytova
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. O. B. Ovsyannikova
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. U. Shayakhmetova
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. S. I. Glukhova
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. A. Garzanova.

Ethics declarations

CONFLICT OF INTEREST

The authors of this work declare that they have no conflicts of interest. The authors are solely responsible for providing the final version of the manuscript. All authors took part in develo** the concept of the article and writing the manuscript. The final version of the manuscript was approved by all authors.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

The study was approved by the local ethics committee of the Nasonova Research Institute of Rheumatology (protocol no. 10 dated June 3, 2021). All study participants signed informed consent.

Additional information

Translated by M. Batrukova

Publisher’s Note.

Pleiades Publishing remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Garzanova, L.A., Ananyeva, L.P., Koneva, O.A. et al. Safety and Tolerability of Rituximab in the Treatment of Systemic Sclerosis. Dokl Biochem Biophys (2024). https://doi.org/10.1134/S1607672924700856

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1134/S1607672924700856

Keywords:

Search

Navigation